Provider Demographics
NPI:1891113478
Name:OSTIS, ANNE ALYSE
Entity Type:Individual
Prefix:MS
First Name:ANNE
Middle Name:ALYSE
Last Name:OSTIS
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:ANNE
Other - Middle Name:ALYSE
Other - Last Name:OSTIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LAC
Mailing Address - Street 1:1467 POMPEY DR
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-4456
Mailing Address - Country:US
Mailing Address - Phone:408-691-7694
Mailing Address - Fax:
Practice Address - Street 1:321 LOS GATOS SARATOGA RD
Practice Address - Street 2:
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95030-5310
Practice Address - Country:US
Practice Address - Phone:408-691-7694
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-01
Last Update Date:2014-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC15857171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist